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Name of the Patient : Abc Xyzkant P. Dlmn / M / 48 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O gait ataxia, memory impairment and mild speech disturbances since 8 months.
Known hypertensive. On Rx.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There are ill-defined, hyperintense areas on the T2 Weighted images in the right inferior cerebellar hemisphere, left cerebellar hemisphere, laterally and in the periventricular white matter, central semiovale and corona radiata bilaterally. These lesions most likely represent ischemic changes.

Lacunar infarcts are noted in the pons, thalami, corona radiata and centrum semiovale bilaterally.

There is mild fullness of both the lateral, third and the fourth ventricles. There is prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally.

There is no shift of the midline structures.

Incidental note is made of a small right antral polyp.

INTRACRANIAL MRA :

The vertebro-basilar system is ectatic. The left vertebral artery is hypoplastic.
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There is slight irregularity in the distal portion of the M2 segment of the right middle cerebral artery.

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, left middle cerebral, basilar, right vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The left vertebral artery is hypoplastic as compared to the right.

There is concentric narrowing of the proximal 1.2 cms of the right internal carotid artery from the bifurcation of the right common carotid artery.

The left common carotid artery and its bifurcation and the right vertebral artery are unremarkable.

IMPRESSION :

1. Altered signal in the right inferior cerebellar hemisphere, left cerebellar hemisphere, laterally and in the periventricular white matter, central semiovale and corona radiata bilaterally most likely represent ischemic changes.

2. Lacunar infarcts in the pons, thalami, corona radiata and centrum semiovale bilaterally.

3. Ectatic vertebro-basilar system.

4. Concentric narrowing of the proximal 1.2 cms of the right internal carotid artery from the bifurcation of the right common carotid artery may be due to atherosclerosis.

5. Slight irregularity of the distal portion of the M2 segment of the right middle cerebral artery.



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